India

Evaluation of the Team-Based Goals and Performance Based Incentives (TBGI) Intervention in Bihar

The Team-Based Goals and Performance-Based Incentives (TBGI) intervention, which CARE conceptualized, developed, and implemented as part of the Ananya program in Bihar, leverages the power of incentives and lessons from motivational theory on teamwork and goal-setting to help improve maternal and child health. Under the intervention, CARE set targets for the percentage of eligible beneficiaries in a subcenter catchment area who should have adopted each of seven key health behaviors or goals (Box 1). All frontline health workers (FLWs) in a given subcenter, including the accredited social health activists (ASHAs), Anganwadi workers (AWWs), and the subcenters’ auxiliary nurse midwives (ANMs), received nonmonetary incentives (consisting of small household items) if their subcenters met five of seven goals in a given quarter. The intervention explicitly sought to encourage teamwork and cooperation among FLWs by providing these incentives for achievements by the subcenter as a whole rather than by individual FLWs, and by providing FLWs with information on the concept and importance of teamwork. It included additional elements to motivate the FLWs in each subcenter, such as a service pledge they recited together and a certificate of recognition for subcenters that met their targets in all quarters. Overall, the intervention was expected to lead to improvements in the incentivized outcomes and to broader changes in related, but nonincentivized, outcomes through increased FLW motivation and teamwork. [82 pages]
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Integrated Family Health Initiative: Catalysing change for healthy communities

Recent trends in the Infant Mortality Rate (IMR), Maternal Mortality Rate (MMR), nutritional status, immunization and family planning, as highlighted in Figure 1, 2, 3 and 4, indicate that there are substantial gaps in achieving related MDG goals 4 and 5.

Despite recent gains and commitments from the Government of Bihar (GoB) and active leadership of key stakeholders to improve health infrastructure and outcomes, deep-rooted problems limit the government’s ability to affect lasting change. Persistent barriers include poor quality and availability of frontline and primary health center level services and staff, limited access to services by neglected and marginalized populations, lack of accurate data, lack of effective program management, weak training systems, absence of supervision in health facilities, poor functional integration of interventions, inadequate public health infrastructures, and an underdeveloped and unregulated private sector.

With support from the Bill and Melinda Gates Foundation, the Integrated Family Health Initiative (IFHI) program seeks to support the GoB to improve family health outcomes statewide as well as build their leadership and ownership towards these services. Ultimately this is to accelerate the progress toward MDG 4 to reduce child mortality and MDG 5 to improve maternal health. [12 pages] Read More...

Evaluation of the Information and Communication Technology (ICT) Continuum of Care Services (CCS) Intervention in Bihar

The Information and Communication Technology (ICT) Continuum of Care Services (CCS) intervention was conceptualized and implemented by CARE as part of the Ananya program in Bihar.1 The intervention involves the provision of ICT-enabled mobile-phone-based tools for frontline workers (FLWs) that aim to increase the coverage and quality of services that FLWs provide, enhance their communication with beneficiaries, and facilitate supervision (Box 1 summarizes the features of the ICT-CCS tool). [123 pages] Read More...

Measurement, Learning, and Evaluation Framework for the Bihar Initiative

The Family Health Initiative in Bihar, India (referred to in this report as the “Bihar Initiative”) is one of the foundation’s flagship programs. It represents a new approach to investing in global health, with the goal of yielding greater impacts on health outcomes and mortality, and accelerating progress toward Millennium Development Goals 4 and 5. In particular, the Bihar Initiative takes an integrated approach to improving reproductive, maternal, neonatal, and child health by leveraging and bundling services and delivery mechanisms from several of the foundation’s Global Health Strategies to improve uptake and coverage across the continuum of family health care. These strategies include Maternal, Neonatal, and Child Health; Family Planning; Nutrition; Vaccine Delivery; Tuberculosis; Enteric and Diarrheal Diseases; Pneumonia; and Neglected and Other Infectious Diseases. [60 pages] Read More...

Measurement, Learning, and Evaluation for the Ananya Program (Family Health Initiative in Bihar)

In 2010, the Bill & Melinda Gates Foundation launched the Family Health Initiative in Bihar, India (now named “Ananya”, a Sanskrit word meaning “unique” or “unlike others”). The goals of the Ananya program (2010–2015) are to reduce maternal, newborn, and child mortality; malnutrition; fertility; and morbidity from infectious diseases by developing and implementing innovative and integrated health solutions that involve both the public and private sectors. More specifically, the program aims to expand the reach, coverage, and quality of (1) essential primary health and nutrition services for infants, children, and women of reproductive age; and (2) diagnostic and disease-control services for infectious diseases, including pneumonia, diarrhea, tuberculosis, and visceral leishmaniasis. [68 pages] Read More...

Using Supply- and Demand-Side Strategies to Improve Maternal and Child Health in Bihar, India

This report focuses on the findings from our process study of two early Ananya grants: (1) the Integrated Family Health Initiative (IFHI), led by CARE; and (2) Shaping Demand and Practices to Improve Family Health in Bihar (SDP), led by BBC Media Action. We focused on these two grants because their activities had begun earlier than other grants and had had time to take root. Next, we offer additional detail on the interventions, describe the data collection for the study, and summarize key findings. [120 pages] Read More...

Baseline Findings from the Ananya Evaluation

The Ananya program (ananya is a Sanskrit word meaning “unique” or “unlike others”) was created by the Bill & Melinda Gates Foundation (the foundation) to address some of the important family health challenges in Bihar, one of India’s most populous and poorest states. Ananya started as a five-year program (2011–2015) with the long-term goals of reducing maternal, newborn, and child mortality; fertility; and undernutrition rates in Bihar. To achieve these goals, the foundation is funding a synergistic set of complementary grants focused on improving the reach, coverage, and quality of family health services in two main areas: (1) essential reproductive, maternal, newborn, and child health services and (2) diagnosis and treatment of infectious diseases, including pneumonia, diarrhea, tuberculosis, and visceral leishmaniasis. Since its inception, the program has also expanded to include additional interventions that focus on improving sanitation in Bihar and on strengthening the system for health payments, including health-related incentives for households and incentives and payments for frontline health workers. [126 pages] Read More...

Tamil Nadu Flood Recovery Project Final Report

In 2015, Tamil Nadu witnessed torrential rainfall and subsequent flooding in many of its coastal districts as the North East Monsoon intensified. The flood caused large scale damages to public and private infrastructure, properties, housing and assets resulting in loss of livelihoods for hundreds of thousand people and loss of 470 human lives. It was declared as ‘calamity of severe nature’ by the Government.

CARE was one of the first humanitarian agencies to be on the field to support the flood-hit communities. Poor households in Cuddalore, Kancheepuram and Chennai city were extended with required relief support to tide over the difficult circumstances caused by flooding. Subsequent to the relief support, CARE formulated a proposal to extend support for recovery for some of the worst affected families in the Kumaratchi block of Cuddalore district. CARE launched the ‘Tamil Nadu Flood Recovery Project’ with the support of BNP Paribas, a renowned corporate in financial services.
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Atmanirbhar Project Impact Assessment Report

Implemented between December, 2014 to February 2017 with three months no cost extension, the project targeted newly married adolescent girls and women, women from ethnic and religious minority (Muslim women), groups and poorest strata of women of upper castes in the project VDCs Chhotkiramnagar, Rayapur, Semara, Thu. Pipaharahawa, Maryadpur, Bairghat, Ekala and Tenuhawa. The VDCs are located in mid-western and southern (Murchwar area) part of Rupandehi district. Atamnirbhar project focused to entrepreneurships skills development of women which has economically empowered to women and supported for the institutionalization of the seven cooperatives in project VDCs. These Women Agriculture Cooperatives are directed towards creating the sustainable rural employment, too. The main objective of the project was to make 1500 women members in 8 different women led saving & credit cooperatives and to create enabling-business environment to start up high growth potential women friendly micro business. It had of which 600 will be capable to run their own micro entrepreneurs.
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Madhya Pradesh Nutrition Project (MPNP) Final Report

The Madhya Pradesh Nutrition Project (MPNP) was a project being implemented by CARE India with funds from Cargill, addressing malnutrition in three districts of Chattarpur, Tikamgarh and Panna in the Bundelkhand region of the state of Madhya Pradesh. The project was aimed towards achieving reduction in underweight (severe underweight) and undernutrition among children and creating awareness on issues associated with malnutrition. It also aimed to strengthen governance, accountability and mutual responsibility of service providers and communities. As the project was an opportunity to provide long term support to the state government’s Integrated Child Development Scheme (ICDS) which was attempting to harness human, institutional and financial resources with high quality and with an increase precision and efficiency. Read More...

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